Using multiple touch points in vaccine outreach through reminder systems, such as phone calls, letters, and text messages, can significantly increase vaccine uptake. Several studies have demonstrated the positive impact of these reminder systems on vaccination rates.
Coupling health education interventions with reminder systems adds to the effectiveness in increasing vaccine uptake among specific groups. These interventions encompass various approaches when working with Refugee, Immigrant, Migrant (RIM) communities, including considering the importance of culturally and linguistically appropriate strategies, incorporating motivational interviewing techniques, and addressing potential barriers. It is vital to acknowledge the unique characteristics and needs of the community when designing vaccine outreach efforts, recognizing that tailoring interventions to match the community's context can significantly impact their effectiveness.
This promising practice showcases successful examples of moving individuals from "information to vaccination" among newly arrived RIM communities in Silver Spring, MD, and Tucson, AZ. By combining reminder systems with linguistically accessible, tailored health education and addressing community-specific concerns, these approaches have demonstrated promise in increasing vaccine uptake.
Vaccination Outreach Efforts in the Silver Spring IRC Office
To address vaccine hesitancy among refugee clients, the outreach team in Silver Spring used several strategies. First, culturally responsive and linguistically accessible information. Calls were made in clients' preferred language through interpreters if the Vaccine Outreach Specialist did not speak the clients’ language.
The Vaccine Outreach Specialist also referenced and provided additional linguistically accessible health education materials tailored to communities. Second, in addition to multiple phone calls, the Specialist emailed relevant health education materials to clients. Third, the Specialist utilized motivational interviewing (MI) techniques to engage in meaningful conversations about vaccine hesitancy. These approaches facilitated effective health promotion, catered to specific client needs, and fostered a trusting environment for informed decision-making.
"I believe follow-ups lead to better vaccination rates," said the Vaccine Outreach Specialist. "I had a client whom I scheduled to get his COVID-19 vaccine on a particular day, I called two days after the appointed date and found out he forgot to go his appointment. After the reminder call, he and his family went and got the vaccine, and he sent me the vaccine card via text as proof."
The Specialist reported that the most common reasons clients were vaccine hesitant were access barriers, religious reasons, and misinformation. For example, "it will make me sick in the future," "It is only for sick people; I am perfectly healthy," and "The government wants to put something in us to control us in the future." The Specialist approached these concerns in a nonjudgmental way and personalized her response to address each client's unique concerns and hesitations. For example, for Muslim clients with religious concerns, the Specialist reassured them that the COVID-19 vaccine is Halal and emphasized the religious goal of preserving and protecting life. For clients concerned about side effects, the Specialist shared their own experience and research. The team member followed up these conversations with tailored materials sent via email or text messages in their preferred language. This approach helped build trust and facilitate increased vaccine acceptance among hesitant individuals, often resulting in successful vaccination.
Over an eight-month period from September 2022 to April 2023, the Vaccine Outreach Specialist at the IRC Silver Spring office made a total of 229 calls to refugee clients from diverse backgrounds to increase COVID-19 vaccination uptake.
As a result of the calls made, the team member scheduled appointments for 89 individuals to receive COVID-19 vaccinations, with 64 individuals confirming that they received the COVID-19 vaccine upon follow-up calls.
Vaccination Outreach Efforts in the Tucson IRC Office
The IRC Tucson office is another example of the importance of addressing concerns and hesitancy to increase vaccine uptake through multiple approaches and touchpoints. First, IRC Tucson conducted a COVID-19 Vaccine Intention Survey, a 21-item forced-choice survey designed to elicit participants' knowledge and attitudes about COVID-19 and vaccine intentions. A total of 51 participants completed the survey. 21 RIM community leaders participated in open-ended key-informant interviews (KII). Informants were asked to reflect on the general beliefs and attitudes about COVID-19 within the communities they lived and served, including concerns and fears about COVID-19, preventive practices, and so on, with the goal of understanding and overcoming barriers to vaccination.
The IRC Tucson then employed Community Health Workers (CHWs) who conducted in-person COVID-19 health education sessions designed to address community-specific concerns and provide accurate information about COVID-19 vaccines. CHWs employed are trusted members of their community and are fluent in the communities’ language(s).
Among those not previously vaccinated, over 40% reported changing their minds about getting the COVID-19 vaccine after attending a COVID-19 Health Education session. For those individuals who expressed an intention to vaccinate, IRC Tucson CHWs provided assistance in obtaining COVID-19 vaccines by scheduling vaccination appointments, providing multi-lingual permanent vaccine site flyers, and/or coordinating transportation to permanent COVID-19 vaccine sites based on the individual’s availability.